Phimosis

atrophic phimosis
Fig. 1 . Atrophic phimosis

Phimosis is a narrowing of the orifice of the foreskin to fully expose the head of the penis. Phimosis can be congenital or acquired due to scarring of the foreskin on the grounds of chronic balanoposthitis. There are also atrophic and hypertrophic forms of phimosis. At first the foreskin short (Fig. 1). when the second - longest, homotaurine (Fig. 2). Atrophic form is more characteristic of the acquired phimosis, hypertrophic - for congenital. Temporary phimosis can be a consequence of acute inflammation, trauma, swelling of the foreskin.
During the first years of life boys prepucialna bag is in the closed state (so-called physiological phimosis), slide the foreskin from the glans penis cannot not only because of the narrow openings of the foreskin, but also due to the epithelial bonding of the inner leaf of the foreskin and the glans penis. With age the foreskin in most cases spontaneously is separated from the head of the penis.

hypertrophic phimosis photo
Fig. 2. Hypertrophic phimosis: right - during urination.

Fig. 3. Department of the foreskin from the glans penis with a probe.

Phimosis in boys can be a cause bedwetting (see). Phimosis creates conditions for the development of inflammatory processes under the foreskin.
Dramatically expressed hypertrophic the phimosis urination difficult and painful, urine flows out in a trickle, thus bag foreskin stretched urine, takes the form of a pear. From it after urination follows a certain amount of urine, wetting underwear, which may lead to a wrong conclusion about the presence of urinary incontinence.
In atrophic phimosis main complaint is pain during erection, which hinders the implementation of sexual intercourse. If there is an infringement of the head of the penis in Suzanna the opening of the foreskin, there paraphimosis (see).
Long stagnation of smegma (see) sometimes leads to the formation of stones prepucialna bag - smegmatis. There is evidence that long-term stagnation and decay of smegma when phimosis can lead to cancer of the penis.
The prognosis depends on a timely visit to a doctor and the right of the treatment.
Treatment phimosis adult only surgical - circular circumcision (see Circumcise). Children should try (doctor!) disconnect the fusion of the glans penis and the inner leaf foreskin bloodless method violent exposure of a head and separation of epithelial adhesions metal tip (Fig. 3). After that the head of the penis should be lubricated sterile vaseline oil, and the foreskin again push the crown in order to avoid the development of paraphimosis. Only in rare cases is true of phimosis in children showing surgery. Timely bloodless disclosure prepucialna bag in children, followed systematic observance of his toilet best means of preventing balanit, balanoposthitis (see), the true phimosis and all its complications.

Phimosis. The narrowing of the orifice of the foreskin, not allowing to pull her over the head of the penis, called phimosis. Phimosis can be congenital and acquired (Fig. 68).

Fig. 68. Phimosis.
a - domestic leaf foreskin; b - the outer leaf of the foreskin.

The narrow opening prepucialna bag with the growth of a child is often stretched, and makes the full opening of the glans penis, and in other cases the narrowing is persistent.
Purchased Timothy are formed due to inflammation of the inner leaf of the foreskin and the glans (see balanitis and balanoposthitis), hard and soft chancre head and foreskin, and also due to scarring and growths last head after these diseases.
In prepucialna bag becomes concentrated whitish sebaceous matter - smegma that you want to remove every day by washing. If phimosis is impossible. Stagnant smegma is decomposed, which is accompanied by phenomena of balanoposthitis, or condensed, inkrustiruetsya salts and forms stones that can cause ulcers and decubitus prepucialna bag. Pronounced phimosis with point-hole may cause a delay of urine and even expansion of the upper urinary tract (ureterohydronephrosis).
In early childhood can often reveal prepucialna bag and expose the glans, without resorting to surgery. In the opening of the foreskin impose metal probe, which carefully disconnect loose adhesions between the head and foreskin, stupid by expanding the hole and bare head.
In adults, the treatment of phimosis exclusively surgery. The most common is circular excision of the prepuce (circumcisio). Both sheets foreskin longitudinally cut on the back surface above entered globulinam probe, then from the end of the section make a circular cut both leaves of the foreskin and stitching leather with a border of internal reports on the section line. When the circular incision need to spare the bridle, in order not to damage passing it the vessel.